Age, race and sex disparity found in cancer research trial participation

Although people age 65 and older account for 62 percent of patients with lung, colon, breast or prostate cancer, they make up only 32 percent of cancer research participants, Yale researchers report in the June 9 Journal of the American Medical Association.

"We found that cancer research participation varied significantly across sex and racial/ethnic groups as well as age," said principal investigator Cary Gross, M.D., assistant professor of internal/general medicine at Yale School of Medicine. "Enrollment in cancer trials is low for all patient groups, but the elderly, racial and ethnic minorities, and women were less likely to enroll in cooperative group cancer trials than were whites, men and younger patients. Overall, less than two percent of adult patients with cancer are enrolling in research studies."

Gross and co-authors analyzed data on participants in the therapeutic non-surgical National Cancer Institute Clinical Trial Cooperative Group. This included breast, colorectal, lung and prostate cancer clinical trials from 2000 through 2002. In a separate analysis, the ethnic distribution of patients enrolled in 2000 through 2002 was compared with those enrolled in 1996 through 1998.

Gross said that while the total number of cancer patients enrolled in research studies increased by almost 50 percent between 1996 and 2002, the proportion of trial participants who were non-white declined during this time period. The team found that while blacks had significantly lower enrollment rates in breast, lung and colorectal cancer trials compared with whites, the representation of blacks and whites in prostate cancer trials was comparable. "This shows that equitable representation between races is possible, and investigators should assess how the prostate cancer researchers were so good at recruiting black patients," said Gross.

The study also demonstrates that elderly patients, both minorities and whites, were strikingly underrepresented compared with their non-elderly counterparts. "This low participation rate has been remarkably consistent over the past decade," said Gross.

"These findings are of concern, given the substantial cancer burden borne by minorities and the elderly," Gross added. "It is apparent that other policies and initiatives will be required to ensure broad access to trials and broad applicability of their results."

Other authors on the study included Vivek H. Murthy, M.D. and Harlan M. Krumholz, M.D.

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